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  • Title: [Acute neonatal appendicitis in an inguinal hernia].
    Author: Guelouz N, Rigourd V, Dommergues MA, Rizkallah J, Ayachi A, Kieffer F, Magny JF.
    Journal: Arch Pediatr; 2003 Dec; 10(12):1079-82. PubMed ID: 14643538.
    Abstract:
    UNLABELLED: Acute neonatal appendicitis is a rare surgical emergency. Prognosis depends on early diagnosis and management. CASE REPORT: A three and a half-month-old premature infant needed an urgent laparotomy because of an occlusive syndrome and sepsis with an inflammatory skin reaction. The per-operative diagnosis was suppurative acute appendicitis with local peritonitis, the appendix being strangulated into the inguinal hernia. DISCUSSION: Neonatal appendicitis represents 0.1% of all infantile appendicitis. Fifty percent of such cases occur in premature infants. Two clinical presentations exist, whose diagnosis is often made during surgery. The abdominal presentation (2/3 of the cases) can mimic necrotizing enterocolitis; the diagnosis is often late and evolution leads to diffuse peritonitis in the majority of the cases, while the mortality rate is higher than 50%. The intra-hernial presentation (1/3 of the cases), instead, is usually diagnosed and managed early due to the inguino-scrotal induration, while mortality rate is near zero. CONCLUSION: The high frequency of inguinal hernia in premature infants should not mask the risk for intra-hernial appendicitis. Inguino-scrotal inflammation should evoke the diagnosis. Prognosis depends on early and urgent surgical management.
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